I am sorry for your fatigue. I've recently recovered from TSR, and my fatigue lingered for months. Having previously done TKR with no such lingering fatigue, it was tremendously frustrating. Meeting with my Dr, we reviewed my meds, eliminated some, and my fatigue is almost eliminated. Perhaps a med review and such a discussion would benefit you as the effectiveness of some meds change over time.

May you be blessed with improved health.